The treatment of simultaneous choriocarcinoma in mother and baby

Treatment of infantile choriocarcinoma of the liver

Primary choriocarcinoma of the liver is an extremely rare childhood malignancy frequently associated with clinical instability at initial presentation. It often mimics other benign and malignant childhood liver tumors. Prompt diagnosis and initiation of treatment are necessary to attain a successful outcome. We describe a critically ill infant with metastatic choriocarcinoma whose diagnosis was based on radiographic and tumor marker findings, without an initial biopsy, and her successful management with neo-adjuvant chemotherapy and delayed surgery. She is currently in continuous remission 24 months from diagnosis.

[Infantile choriocarcinoma: an uncommon and curable tumor]

Choriocarcinoma is a malignant growth of trophoblastic cells characterized by secretion of human chorionic gonadotropin (hCG). Infantile choriocarcinoma is a very rare tumor, which is a complication of gestational choriocarcinoma and usually had very poor prognosis before chemotherapy was used. We report 1 new case as well as a review of the literature since 1945. Our case report describes the successful treatment by chemotherapy of a newborn with cerebral metastasis. Several features are important: Infantile choriocarcinoma occurs in infants aged 0 to 6 months. Anemia, hepatomegaly and hemorrhagic syndromes are the main symptoms with sometimes cerebral, cutaneous or ear-nose and throat localisations. But diagnosis can be difficult when clinical symptoms are poor. The main diagnostic criterion is a very high plasmatic or urinary level of hCG or beta-hCG in the newborn. Histological pattern is not mandatory for diagnosis. Thoracoabdominal CT scan and cerebral MRI are necessary to find metastases. Recommended treatment is chemotherapy and surgery is discussed when a tumoral residue remains. Post-treatment surveillance is based on clinical and radiological examination as well as negativation of beta-hCG. Choriocarcinoma occurring simultaneously in mother and child have been reported. Therefore it is necessary to assay maternal serum beta-hCG when infantile choriocarcinoma is disclosed and to assay serum beta-hCG in the newborn when the mother has gestational choriocarcinoma. Infantile choriocarcinoma is a very chemosensitive tumor and is thereby potentially curable. Early diagnosis is the most important prognostic factor.

Placental site trophoblastic tumor (PSTT) in mother and child: first report of PSTT in infancy

BACKGROUND

To the authors' knowledge, placental site trophoblastic tumors occurring simultaneously in mother and infant have not previously been reported.

PROCEDURE

The clinicopathologic features of metastatic placental site trophoblastic tumor in a mother and her 4-month-old son are described.

RESULTS

The disease in the infant was aggressive, and he died in multiorgan failure within 5 weeks of hospital admission. Autopsy showed widespread metastases to liver, lungs, pleura, kidney, mesentery and lymph nodes. The mother, who had a uterine tumor and lung metastases, was treated with chemotherapy and hysterectomy and has no evidence of disease 26 months post-treatment.

CONCLUSIONS

This report shows that placental site trophoblastic tumors can metastasize in both mother and child.

Disseminated choriocarcinoma in infancy is curable by chemotherapy and delayed tumour resection

Infantile choriocarcinoma has a poor prognosis with only 2 surviving children reported in the literature. 2 additional successfully treated children are presented. 2 infants (age 3 and 4 months at diagnosis) suffering from rapidly progressive choriocarcinoma with widespread haematogenous metastases involving the liver were treated according to the cooperative germ cell tumour treatment protocol (MAKEI 96) of the German Society of Pediatric Oncology and Hematology (GPOH). PEI-chemotherapy (cisplatin, etoposide, ifosfamide; no ifosfamide before the age of 4 months) was combined with delayed tumour resection. Treatment resulted in sustained remission in both children (event-free survival 42 and 40 months). Interphase fluorescent in situ hybridisation (FISH) analysis of the paraffin-embedded tumour sample from case one revealed four to eight copies of chromosomes X, 1 and 17 and two Y chromosomes. Hybridisation with sub-telomere and centromere specific probes for chromosome 1 displayed an imbalance between the short and long arms of chromosome 1. In the tumour cells from case 2, only a polysomy of chromosome X could be proven, other aberrations were not analysed in this case for technical reasons.

Choriocarcinoma in infant and mother: a case report

We present a case of gestational choriocarcinoma that developed in a pregnant woman with metastases to her baby. In this case, severe anemia and hepatomegaly of the baby were noticed after delivery. Despite intensive treatments, the tumor progressed rapidly, and the baby died at the age of 38 days. Accurate diagnosis was made after autopsy. When the baby's mother visited our hospital again at 4 months postpartum, there were widespread multiple metastases to her lungs and liver. We want to emphasize that if a neonate or infant has anemia and/or hepatomegaly, it is necessary to be aware of the possibility of infantile choriocarcinoma with the presence of an occult tumor in the mother and to examine the mother's and infant's hCG levels immediately.

Simultaneous choriocarcinoma in mother and newborn infant

A male infant, born following an uncomplicated pregnancy, was severely anaemic at birth following significant foeto-maternal haemorrhage. At three weeks of age a tumour was found in the liver with evidence of metastatic disease in the lungs. The infant died before treatment could be started. Postmortem revealed choriocarcinoma which led to subsequent diagnosis in the mother who also had pulmonary metastases. The mother has been successfully treated. The case is described in detail and followed by a discussion and a literature review of reported cases of simultaneous choriocarcinoma in infant and mother.

Metastatic choriocarcinoma in an infant: imaging appearance

Metastatic choriocarcinoma is unusual in infancy and considered to be due to metastases from the placenta. Only fifteen cases have been previously reported. We present an unusual case of hepatic, pulmonary, and axillary lymph node metastases from choriocarcinoma in a 3-month-old female. Several of the lesions had large vascular channels identified by computed tomography and sonography with color and duplex Doppler.